title: Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis.
abstract: OBJECTIVE
  Although regular physical activity has beneficial cardiovascular effects, exercise can trigger an acute cardiac event. We aimed to determine the incidence and prognosis of exercise-related out-of-hospital cardiac arrest (OHCA) in the general population.
  
  
  RESULTS
  We prospectively collected all OHCAs in persons aged 10-90 years from January 2006 to January 2009 in the Dutch province North Holland. The relation between exercise during or within 1 h before OHCA and outcome was analysed using multivariable logistic regression, adjusted for age, gender, location, bystander witness, bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, initial rhythm, and Emergency Medical System response time. Of 2524 OHCAs, 143 (5.7%) were exercise related (7 ≤35 years, 93% men). Exercise-related OHCA incidence was 2.1 per 100 000 person-years overall and 0.3 per 100 000 person-years in those ≤35 years. Survival after exercise-related OHCA was distinctly better than after non-exercise related OHCA (46.2 vs. 17.2%) [unadjusted odds ratio (OR) 4.12; 95%CI 2.92-5.82; P < 0.001], even after adjustment for abovementioned variables (OR 2.63; 95%CI, 1.23-5.54; P = 0.01). In the 69 victims aged ≤35 years, exercise was not associated with better survival: 14.3 vs. 17.7% in non-exercise-related OHCA (OR 0.77; 95%CI 0.08-7.08; P = 0.82).
  
  
  CONCLUSIONS
  Exercise-related OHCA has a low incidence, particularly in the young. Cardiac arrests occurring during or shortly after exercise carry a markedly better prognosis than non-exercise-related arrests in persons >35 years. This study establishes the favourable outcome of exercise-related OHCA and should have direct implications for public health programs to prevent exercise-related sudden death.
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, The Netherlands.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Berdowski
authors.forename: Margriet F
authors.initials: MF
authors.lastname: de Beus
authors.forename: Marieke
authors.initials: M
authors.lastname: Blom
authors.forename: Abdennasser
authors.initials: A
authors.lastname: Bardai
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Doevendans
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Hanno L
authors.initials: HL
authors.lastname: Tan
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Rudolph W
authors.initials: RW
authors.lastname: Koster
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D017678:Sex Distribution; D015996:Survival Rate; D055815:Young Adult
keywords: Cardiac arrest; Exercise; Incidence; Prevention; Resuscitation; Survival